A New Effort to Ease the Doctor Shortage

Legislatures will consider an interstate compact next year that could make it easier for doctors to get licenses in other states, which could be a boon to rural areas that don't have enough medical care.

States have a long history of making agreements with one another as a way to act without the federal government. The latest such compact circulating in state legislatures for 2015 would make it easier for doctors to get licenses in multiple states so they can practice medicine in person or remotely.

The Interstate Medical Licensure Compact would essentially create express lanes for highly qualified doctors who would normally have to endure long waits navigating different processes with individual state medical boards. The aim is to encourage doctors who want to practice at least part-time in another state or through digital platforms but are hesitant because they consider the effort of obtaining multiple licenses too daunting.

Right now, only about 6 percent of physicians have licenses in more than two states, according to the Federation of State Medical Boards (FSMB), which developed the compact. But critics of the compact, who prefer that doctors have a single license recognized across all states, say it still doesn't go far enough.

Like all interstate compacts, the licensure agreement, which was finalized in September, requires the approval of individual state governments. The Federation of State Medical Boards is now gearing up to promote the compact it drafted in state legislatures next year. So far, eight medical boards have publicly endorsed the idea, including those of Alabama, Maine, Texas and Wisconsin. FSMB is hoping at least seven states pass the compact in its first year to give it enough participants to develop rules and processes.

Licensing and discipline has long been the purview of state medical boards in the United States. The Federation argues this system promotes public safety at the local level, but its varying requirements can also be hard to navigate. Doctors who want a license in another state have to seek an endorsement through that state’s medical board, which is a similar process for those seeking their first license in that state. The Federation declined to estimate the average amount of time it takes an out-of-state doctor to obtain an endorsement license, but a 2012 article from American Medical News said it can take up to a year.

The interstate compact would set threshold requirements that participating states agree to, and a doctor’s home state would verify that they’ve met those requirements, which include clean disciplinary records, holding a specialty certification, passing licensure exams within three attempts and completing a residency. The compactitself would coordinate an expedited license with other states after the doctor’s home state verified his or her qualifications, relieving the other state medical boards of some processing duties, said Dr. Humayun J. Chaudhry, president and CEO of FSMB.

“The Commission will be able to streamline that,” he said. “There is an infrastructure already in place, but if you ask most states, their resources are limited, so an interstate commission -- made up of the states -- would enable some of the paperwork to be managed in a much more efficient way, and we might be able to find a way to manage the renewal process.”

Doctors would still have to abide by the medical laws in the states where they hold licenses. Participating states would still offer the traditional route of licensure for those who don’t meet the interstate commission’s requirements, which supporters say are more rigorous than states typically require.

“That’s kind of the assurance to legislatures and others that, ‘Hey this isn’t going to be the lowest way over the fence,’ so to speak,” said Kevin Bohnenblust, the executive director of the Wyoming Board of Medicine. “You’re going to be getting good people."

For Wyoming -- one of the largest states by land area but smallest states by population -- the opportunity for doctors from neighboring states to practice more easily part-time in critical areas is a huge benefit, Bohnenblust said. Nationally, about 25 percent of the U.S. population lives in rural areas while only 10 percent of physicians practice there, according to the National Rural Health Association.

Those kinds of access problems have helped fuel the growth of telemedicine, which some analysts expect to reach $1.9 billion in 2018 from several hundred million today. FSMB had telemedicine in mind when it crafted the compact because doctors engaging with patients in different states electronically still require licenses to practice in those states. But the only public criticism of the compact so far has come from the telemedicine industry.

Gary Capistrant, the director of public policy for the American Telemedicine Association, argues the compact doesn’t go far enough. For one, he said, doctors will still have to pay fees for additional licenses, which can cost more than $1,000. There’s also no guarantee that creating another layer of authority will speed up processes in individual states, he said. That would take reciprocity in the way all states recognize different drivers’ licenses, Capistrant said.

The nursing profession already has a degree of mutual recognition across state lines, and other medical professions are similarly pushing for greater measures of reciprocity. Without a similarly bold idea, Capistrant said, he doubts supporters in state legislatures will commit time and effort on it.

“It takes effort to get legislation through the legislatures, particularly those that have very short sessions, and if something doesn’t have a lot of support, it just doesn’t make it through the process that fast,” he said. “Our concern is that the proposal is such a small step that it might not garner the kind of enthusiasm to make its way through.”

Chaudhry said FSMB considered a mutual recognition model but member boards insisted on the ability to issue their own licenses in their jurisdictions because those licenses give people a legal right to independently diagnose, treat and prescribe. Doctors are also subject to individual state laws, he noted.

“The primary mission of a board is protecting the public, and that’s best done at the local level,” Chaudhry said.

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